The rise of dental tourism

Discount dental destinations

How far would you be willing to travel to see a dentist? A few suburbs? Across the city? Maybe even interstate? Would you fly to another country? It may sound excessive but, as dental costs continue to rise, some people are choosing to travel overseas for treatment. With reported savings of up to 75% in some countries, it's not surprising a growing number of people are packing their bags to chase cheap dentistry via dental tourism abroad.

Medical tourism agencies

If you're up for it, there are plenty of medical tourism agencies to help you on your way. Many offer a range of medical options - from cosmetic surgery to elective surgery, eye surgery and fertility treatment while others specialise in one area, such as dental.

These agencies will organise your flights, accommodation and even sightseeing (but not travel insurance, in case a procedure goes wrong). They will provide advice on hospitals regarding their success rates and complications, and whether they are accredited by organisations such as the International Organization for Standardizations or the Joint Commission International.

Where to go

There are plenty of exotic countries to choose from, but most Australians looking for discount dental work are flocking to Malaysia and Thailand. Bumrungrad International Hospital in Bangkok sees 11,000 overseas visitors, with about 500-600 Australians walking through the doors, according to Marketing Director Kenneth Mays. "We provide a complete dental centre, staffed by 55 full- and part-time dental specialists, 26 [of whom] trained and/or have been board-certified in the US, UK, Japan or Australia," he says.

Barbara Sherriff, who owns Queensland travel agency My Body and Spirit, specialises in sending clients to Thailand for dental work, cosmetic surgery and laser eye surgery. She says the business came about as a result of her husband's dental woes. "He needed significant dental treatment and was quoted $25,000, which was just far too much."

Sheriff, a travel agent already familiar with Thailand, looked into having the treatment there instead. She visited The Bangkok Hospital in Phuket with her husband, and was impressed with the facilities, not to mention the cost - $5500.

As a result, the couple started a health travel service to Thailand which sent more than 160 clients to Thailand in 2011, 75% of whom were for dental. "We've seen people who've been quoted up to $60,000 for substantial work and simply cannot afford to have it done in Australia," she explained. "We now receive up to 20 enquiries a week, and most of these are from people wanting dental work."

Teething problems

"For a third of the price and a holiday at the same time it sounds like an offer that's too good to be true - but it isn't that good," says former Federal President Dr John Matthews. "Most people go overseas because they want fairly complex dentistry done, and the more complex it is, the more likely that something will go wrong. And when it fails, it fails big time."

Dr Carmelo Bonanno, a Canberra dentist and Federal Executive of the ADA, says people need to understand the implications of taking their dental care offshore. "Overseas dentists may or may not have the training and experience, but with your Australian dentist it is very clear. If you see me you know where I've been trained and that I'm registered, and if you're not happy with the work there are avenues to complain."

Bonanno says if people choose to head overseas, they may be in for unexpected additional costs. A former patient of his chose to go to Asia for cosmetic dentistry, which was so badly done, it will take significant work and a lot more money to get it fixed at home.

Scaremongering?

The medical travel agents CHOICE spoke to say they've had no complaints from the customers they deal with and that they provide a full estimate of the time required for treatment before their clients even book a flight, as well as a high level of care in quality hospitals.

"Our clients' cases and x-rays are reviewed by the head of dental in The Bangkok Hospital, and all the details are put into place meticulously," says Sheriff.

Cassandra Italia owns Global Health Travel, which offers similar services to My Body and Spirit. She feels that detractors of medical tourism have a level of ignorance about the countries in question.

"A lot of people in Australia have a perception that countries such as Thailand, Vietnam and India would have bad conditions in the hospitals, maybe slack infection control and be very Third World. Certainly from my experience visiting the Bangkok and Bumrungrad hospitals, I didn't find this the case. Bumrungrad has a surgical site infection rate of only 0.39%, which is well below the worldwide benchmark."

Italia believes much of this talk is scaremongering by those wanting to keep their patients. She says many of her clients have been refused access to their dental records or x-rays by local dentists if they want them to take overseas. "We tell people to get a referral from a GP to see a radiologist in order to get the x-rays," says fellow agent Sheriff.

Before you bite

Despite the divided opinions, both sides of the argument agree that if you decide to seek treatment overseas, you'll be going it alone. It's unlikely you'll be able to get travel insurance, and with no clear avenues to complain if you aren't happy with the work, there are risks.

Furthermore, the agencies that organise your treatment and travel make it clear they're only providing the tools and information to allow the customer to make the final choice. Global Health Travel's website clearly states: "We will not encourage, advise, advocate or underwrite any of the doctors or healthcare facilities in our network. The final choice is completely yours."

If you are considering overseas treatment:

Research online or try to visit the hospital beforehand. Look for reviews or places recommended by expatriates living in that country. Many hospitals provide background details on their dentists, including qualifications and where they trained.

Ask questions. Ask for a full treatment plan and ask about the time frame, as well as the total costs.

Make time. Don't book an inflexible airfare or limited annual leave, as you may need to stay longer than expected.

Accept that you may need to go back for more work. You may lose the savings you made initially.

If you decide to stay at home:

Extras insurance will help pay for some dental costs, but it won't pay for everything.

Set up a fund if extras insurance is too costly - consider putting aside money each month for future dental costs. It takes discipline, but the alternative (ie. being caught short and needing to borrow money or forgo treatment) is worse.

Check the details because serious oral and maxillofacial surgery may fall under your hospital insurance.

Look after your teeth. Good preventative dental care will help avoid problems in the first place.

Case studies

After a pricey trip to the dentist, CHOICE journalist Kate Browne wondered if staying at home for dental work was worth the added expense.

"A check-up with my dentist left my head spinning and it wasn't from the gas. Just 18 months after my last visit, the prognosis wasn't good.

A pregnancy with severe morning sickness had taken its toll. It turns out that vomiting every day is not only revolting but isn't great for your teeth either. The result? Acid damage and cavities, which required nine new fillings. To make matters worse, I also needed root canal work and a crown.

The estimated out-of-pocket cost after my private health cover was more than $6000. In a family of four with just one working member (I was on maternity leave), an unexpected $6000 isn't welcome.

Having travelled to Thailand before, I researched it as an option. A return fare to Bangkok at the time was about $869, accommodation in a basic hotel was $378 for three weeks, and the same dental work at a well-known international hospital was estimated at $1800. Throw in a little spending money and time in one of my favourite cities and I would've still been almost $3000 better off.

The only thing that stopped me from jumping on a plane was my toddler, baby and a husband who might not forgive me for leaving him with the kids while I flew halfway around the world for about a month. As a result I reluctantly took the local option, and while the work was excellent, several months later I am still paying off the bill."

We also spoke to CHOICE reader David Sanderson, who travelled from Sydney to Thailand for major dental surgery, including implants and a replacement crown.

"I'd used up my lifetime insurance limits for periodontic work and faced paying the entire amount."

David did his research before making a decision, going online for names of dentists and surgeries. He then trawled online discussion forums for recommendations, particularly those where expatriates discussed the best places. In the end he was happy with the work, the standards at the clinic and the entire cost, which was less than half of what he was quoted in Australia.

"I also believe my Thai dentists were more expert and knowledgeable than my Australian dentist. My Australian dentist recommended getting crowns on all my upper teeth, but my Thai one convinced me that was not advisable and also replaced my broken crown with a type that was likely to be more durable."

However, David says it's important to research before choosing a clinic. "There were other clinics I saw that I wouldn't recommend. Find out if the clinic you've chosen has a good reputation and be prepared to pay more for higher quality - you'll still be getting a bargain."